ABUNDANT GRACE WELLNESS, LLC
NPI 1962092114
Nurse Practitioner - Adult Health in Charleston, SC
About Abundant Grace Wellness, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ABUNDANT GRACE WELLNESS, LLC (NPI 1962092114) is a healthcare organization registered as an adult health in Charleston, South Carolina and active in the NPI registry since January 2021. The organization lists Gloria Katherine Wilson, Authorized Official/provider, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Abundant Grace Wellness, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Abundant Grace Wellness, LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Abundant Grace Wellness, LLC's NPI number?
The NPI number for Abundant Grace Wellness, LLC is 1962092114. It was assigned to this organization in the NPPES registry on January 21, 2021.
Where is Abundant Grace Wellness, LLC located?
Abundant Grace Wellness, LLC is located at 2045 Maybank Hwy, Charleston, SC 29412. The listed phone number is (843) 801-0861.
What is Abundant Grace Wellness, LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.
Is Abundant Grace Wellness, LLC enrolled in Medicare?
Yes. Abundant Grace Wellness, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Abundant Grace Wellness, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Abundant Grace Wellness, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Abundant Grace Wellness, LLC was last updated on September 14, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Abundant Grace Wellness, Llc · NPI 1962092114
Adult Health organization in Charleston, South Carolina. Organization record, active in the CMS NPPES registry since January 21, 2021.
## Identity
- **NPI:** 1962092114 (Entity type: Organization)
- **Enumerated:** January 21, 2021
- **Primary specialty:** Nurse Practitioner - Adult Health · taxonomy 363LA2200X
- **Organization subpart:** No
- **Authorized official:** Gloria Wilson, AUTHORIZED OFFICIAL/PROVIDER
## Practice location
- **Address:** 2045 MAYBANK HWY, Charleston, SC 29412
- **Phone:** (843) 801-0861 · **Fax:** (843) 768-1473
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 14, 2023
- **Other identifiers:** Other 18678 (SC)
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Source: [NPI Profile](https://npiprofile.com/npi/1962092114) · Data from the CMS NPPES public registry.